Provider Demographics
NPI:1467605857
Name:SELVA GANESH, MD, PA
Entity Type:Organization
Organization Name:SELVA GANESH, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SELVA
Authorized Official - Middle Name:
Authorized Official - Last Name:GANESH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-732-3200
Mailing Address - Street 1:211 E BOYNTON BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-3839
Mailing Address - Country:US
Mailing Address - Phone:561-732-3200
Mailing Address - Fax:561-732-6849
Practice Address - Street 1:211 E BOYNTON BEACH BLVD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-3839
Practice Address - Country:US
Practice Address - Phone:561-732-3200
Practice Address - Fax:561-732-6849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-29
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0025890174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265927100Medicaid
FL265927100Medicaid